Diapositiva 1

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New Challenges for public services social
dialogue Integrating service users and workforce
involvement to support the adaptation of social
dialogue Utrecht University School of
Governance- June 6th 2014
The Italian Case Lorenzo Bordogna and Stefano
Neri University of Milano
With financial support from the European Union
VP/2013/0362
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The interviews

• 14 interviews
• Education
• 2 employer representatives (level 1 regional, 1
  school)
• 3 union representatives (level 1 national, 1
  regional, 1 local)
• 1 user representative (involved at both regional
  and school levels)
• 1 representative of a municipality (a mediator
  between users and employer)
• Health care
• 1 employer representative (national level)
• 3 union representatives (level 2 national, 1
  regional)
• 2 user representatives (involved at both regional
  and hospital levels)
• 1 expert in the field (a national research
  institute representative working in patient
  involvement projects)

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Service user pressure

• In both sectors increasing role of the single
  users
• Choice policy (especially in health care)
• Admistrative and judiciary claims (especially in
  health care)
• Main drivers
• increasing user awareness of entitlement
• declining doctor and teacher authority
• 2) Collective forms of participation, legally
  recognised, are significant at organisational and
  local level, weak or very weak at regional and
  national level
• 3) At national level, users association act as
  pressure groups, not legally recognised, on
  specific issues

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Actors who are the users?

• Education
• Individually parents and students
• Collectively parent association and committees,
  student associations
• 2) Health care
• Individually patients and patient families
• Collectively patient associations, voluntary
  organisations providing health care services
  (often patient associations) and other
  organisations promoting patient and citizen
  rights in health and social care
• Focus on collective forms of user participation

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Collective forms of user involvementEducation

• National legal framework (1974 1999)
• 1) Collegial bodies at single school level
  (School Councils)
• Members parent and student representatives,
  staff representatives, headmaster
• User and staff representatives are directly
  elected
• Consultative and deliberative functions (e.g.
  extra-time activities, supplementary courses)
• Some powers in working time distribution and in
  resource management (e.g. supplementary courses)
• 2) Territorial bodies (Province Councils,
  School District Councils), with user and staff
  representatives abolished in 1999 and not
  replaced by other representation boards (so far)
• 3) National user representation boards never
  existed

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Collective forms of user involvementHealth care

• National legal framework (1992), but also very
  relevant regional regulation
• 1) Boards (Joint Consultative Committees,
  Participation Units), including staff and user
  representatives, at Local Health Authority or
  Hospital Trust level (single-employer level)
• Users representative selected among patient
  associations and voluntary sector organisations,
  appointed by managers of the public healthcare
  organisations
• Main functions
• Cooperation in the definition of the quality and
  service access standards
• Control and monitoring of quality and service
  access standards
• However high level of regional and local
  differences

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Collective forms of user involvementHealth care

• 2) In some Regions, there is a regional board,
  (Regional Joint Consultative Committees,
  Regional Participation Units) including staff
  and users representatives
• Members appointed by the regional Minister of
  Health
• Main functions
• Coordination of the activities and initiatives of
  the single organisation committees
• Consultation in Regional policies concerning
  quality and service access
• However the Regional level boards are less
  important and widespread than the single
  organisation boards
• 3) No national boards or other statutory forms of
  participation
• At national level political pressure by patient
  associations on single pathology issues

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Social dialogue and service user involvement

• 1) Relevant differences between users role in the
  two public service sectors, but quite similar
  relationship between service user involvement and
  social dialogue
• 2) The forms of user involvement are separate
  from social dialogue institutions
• In both sectors they do not directly deal with
  typical issues of social dialogue (e.g. pay and
  working conditions)
• they do not affect which actors are represented
  within systems of social dialogue
• However they may have indirect influence on
  issues of social dialogue in both sectors. E.g.
• Demand for supplementary courses may lead to
  change in the working time organisation for
  teachers and other staff in schools
• Waiting times or service standard monitoring may
  bring about changes in work organisation, or in
  the staff number employed in a service

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Social dialogue and service user involvement

• 2) Public managers (headmasters, hospital chief
  executives) may be intermediaries between user
  representatives and unions, in case user demands
  may have consequences on pay and working
  conditions
• 3) User associations and unions are occasional
  allies in case of local or national campaigns
  (e.g. campaigns against cuts in school funding or
  in the NHS fund)
• 4) Emerging role of the pensioner unions as user
  associations in health care

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Some critical issues about user representatives

• 1) Training
• 2) Selection and representativeness
• 3) Conflicts among different types of user
  associations

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